While rates of smoking and excessive drinking have declined among older Americans, prevalence of chronic disease has risen, and many older Americans are unprepared to afford the costs of long-term care in a nursing home, according to a report from the U.S. Census Bureau commissioned by the National Institutes of Health.

The report highlights those trends and others among America’s older population, now over 40 million and expected to more than double by mid-century, growing to 83.7 million people and one-fifth of the U.S. population by 2050. Population trends and other national data about people 65 and older are presented in the report, 65+ in the United States: 2010(PDF - 1.7MB). It documents aging as quite varied in terms of how long people live, how well they age, their financial and educational status, their medical and long-term care and housing costs, where they live and with whom, and other factors important for aging and health.

“This report shows how aging in America is changing in fundamental ways,” said Richard Suzman, Ph.D., director of NIA’s Division of Behavioral and Social Research. “Not only does it provide the number of older people and their age, sex, and race, it also tells us about their health, families, communities and future problems with caregiving, vital data to consider as we seek to meet the needs and address concerns of an aging population. The older population today is increasingly diverse, on a number of fronts.”

A key aspect of the report is the effect that the aging of the baby boom generation — those born between 1946 and 1964 — will have on the U.S. population and on society in general. Baby boomers began to reach age 65 in 2011; between 2010 and 2020, the older generation is projected to grow more rapidly than in any other decade since 1900.

The report points out some critical health-related issues:

Rates of smoking and excessive alcohol consumption have declined among those 65 and older, but the percentage of overweight and obese people has increased. Between 2003-2006, 72 percent of older men and 67 percent of older women were overweight or obese. Obesity is associated in increased rates of diabetes, arthritis, and impaired mobility, and in some cases with higher death rates.

Research based on NIA’s Health and Retirement Study suggests that the prevalence of chronic diseases, such as high blood pressure, heart disease, chronic lung disease, and diabetes, increased among older people between 1998 and 2008. For example, in 2008, 41 percent of the older population had three or more chronic conditions, 51 percent had one or two, and only 8 percent had no chronic conditions.

The cost of long-term care varies by care setting. The average cost of a private room in a nursing home was $229 per day or $83,585 per year in 2010. Less than one-fifth of older people have the personal financial resources to live in a nursing home for more than three years and almost two-thirds cannot afford even one year. Medicare provides coverage in a skilled nursing facility to older and disabled patients for short time periods following hospitalization. Medicaid covers long-term care in certified facilities for qualifying low-income seniors. In 2006, Medicaid paid for 43 percent of long-term care.

“Most of the long-term care provided to older people today comes from unpaid family members and friends,” noted Suzman. “Baby boomers had far fewer children than their parents. Combined with higher divorce rates and disrupted family structures, this will result in fewer family members to provide long-term care in the future. This will become more serious as people live longer with conditions such as cancer, heart disease and Alzheimer’s.”

Other areas covered in the report include economic characteristics, geographic distribution, social and other characteristics. See highlights below.

“We hope this report will serve as a useful resource to policymakers, researchers, educators, students and the public at large,” said Enrique Lamas, the Census Bureau’s associate director for demographic programs. “We sought to develop a comprehensive reference with up-to-date information from a variety of reliable sources.”

65+ IN THE UNITED STATES: 2010 - HIGHLIGHTS

Population Characteristics

In 2010, there were 40.3 million people aged 65 and older, 12 times the number in 1900.

The percentage of the population aged 65 and over among the total population increased from 4.1 percent in 1900 to 13.0 percent in 2010 and is projected to reach 20.9 percent by 2050.

From 2010 onwards, the older dependency ratio — the number of people aged 65 and over per 100 people aged 20 to 64 — is expected to rise sharply as the baby boomers enter the older ages. In 2030, when all baby boomers will have already passed age 65, the older dependency ratio is expected to be 37, which translates into fewer than three people of working age (20 to 64) to support every older person.

The older population has become more racially and ethnically diverse, with those identifying their race as white alone comprising 84.8 percent in 2010, down from 86.9 percent in 2000.

Health and Long-term Care

Over 38 percent of those aged 65 and over had one or more disabilities in 2010, with the most common difficulties being walking, climbing stairs and doing errands alone.

The share of the older population residing in skilled nursing facilities declined from 4.5 percent in 2000 to 3.1 percent in 2010. The share in other long-term care facilities, such as assisted living, has been growing.

Medicaid funds for long-term care have been shifting away from nursing homes with funding for home- and community-based services increasing from 13 percent of total funding in 1990 to 43 percent in 2007.

Changing marital trends, such as the rise of divorces, as well as the increase in living alone among the 65-and-over population, will likely alter the social support needs of aging baby boomers.

Economic Characteristics

Labor force participation rates rose for both older men and older women in the first decade of the 21st century, reaching 22.1 percent for older men and 13.8 percent for older women. In contrast, the labor force participation rates for the population aged 25 to 34 fell from 2000 to 2010 for both men and women.

The older white alone population was less likely than the older black alone and Asian alone populations to live in poverty. Older Hispanics were more likely to live in poverty than older non-Hispanic white alone residents.

Following the housing price peak in 2006, homeownership rates declined for the population under age 65 but remained flat for older householders.

Housing costs were slightly less of a burden in 2009 compared with 2001 for older householders.

Many older workers managed to stay employed during the recession. The population aged 65 and over was the only age group not to see a decline in its employment share from 2005 to 2010. In 2010, 16.2 percent of the population aged 65 and over were employed, up from 14.5 percent in 2005.

Geographic Distribution

Eleven states had more than 1 million people aged 65 and older in 2010.

States with the highest proportions of older people in their populations in 2010 included Florida, West Virginia, Maine, and Pennsylvania (all above 15 percent).

The West and South regions experienced the fastest growth in their 65-plus and 85-plus populations between 2000 and 2010.

In 2010, more than 7 out of 10 older Hispanics lived in four states: California (26.9 percent), Texas (19.2 percent), Florida (15.7 percent), and New York (9.0 percent).

The vast majority of older people do not move, but their moving rates remained stable between 2000 and 2010, in contrast to the slowdown in migration among younger populations.

Social Trends

The population aged 65 and over was the only age group to see an increase in voter participation in the 2012 presidential election compared with the 2008 presidential election.

In 2010, Internet usage among the older population was up 31 percentage points from a decade prior.

About the National Institute on Aging (NIA): The NIA leads the federal government effort conducting and supporting research on aging and the health and well-being of older people. The Institute’s broad scientific program seeks to understand the nature of aging and to extend the healthy, active years of life. For more information on research, aging, and health, go to http://www.nia.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visitwww.nih.gov.

A review article appearing in Nutrition Journal analyzes the potential impact of the Western diet on the immune system. NIAID scientist Ian Myles, M.D., describes findings from animal and human studies suggesting that modern dietary choices may contribute to more inflammation, poor control of infections, and a higher risk of allergic and autoinflammatory diseases. He also explains how dietary choices can alter DNA and the composition of the microbiome—the community of “good” bacteria that naturally colonize the gut. These changes enable the potentially harmful effects of diet to be passed from parent to child.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Abstract

While numerous changes in human lifestyle constitute modern life, our diet has been gaining attention as a potential contributor to the increase in immune-mediated diseases. The Western diet is characterized by an over consumption and reduced variety of refined sugars, salt, and saturated fat. Herein our objective is to detail the mechanisms for the Western diet’s impact on immune function. The manuscript reviews the impacts and mechanisms of harm for our over-indulgence in sugar, salt, and fat, as well as the data outlining the impacts of artificial sweeteners, gluten, and genetically modified foods; attention is given to revealing where the literature on the immune impacts of macronutrients is limited to either animal or in vitro models versus where human trials exist. Detailed attention is given to the dietary impact on the gut microbiome and the mechanisms by which our poor dietary choices are encoded into our gut, our genes, and are passed to our offspring. While today’s modern diet may provide beneficial protection from micro- and macronutrient deficiencies, our over abundance of calories and the macronutrients that compose our diet may all lead to increased inflammation, reduced control of infection, increased rates of cancer, and increased risk for allergic and auto-inflammatory disease.